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Primary carcinoma of the fallopian tube is a rare disease and has traditionally been managed in the same manner as epithelial ovarian cancer. However, unlike ovarian cancer, fallopian tube cancer is not routinely suspected and treatment may be delayed. The clinical presentations of seven cases of fallopian tube cancer emphasize the need for accurate assessment of symptoms to ensure early diagnosis and treatment of this disease.
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Clinical features of primary carcinoma of the fallopian tube were studied in 13 patients treated in Osaka National Hospital between 1961 and 1987. The relationship between clinical staging and prognosis in each patient is discussed. The incidence of this disease among all cases of malignant tumor in the gynecological department during the same 27-year period was 0.18%. The mean age of the patients was 50.7 years. Twelve patients (92%) were within the age range from 41 to 59 years, the most common age of onset. Six patients (46%) were nulligravida and 9 (69%) were nulliparous, suggesting infertility as a possible important risk factor for the disease. None of the six who underwent cervical cytodiagnosis showed tumor cells. Three were positive for cytodiagnosis by aspiration biopsy. The concomitant use of many drugs, including CDDP given postoperatively to 2 patients with advanced disease, was markedly effective. The radiotherapy carried out in 4 patients was ineffective. When the patients were staged according to the classifications of Dodson et al. and Schiller et al., there was no difference between these classifications in advanced cases. However, Dodson et al.'s classification was considered unsuitable for patients with early-stage cancerous lesions localized in the fallopian tube, while that of Schiller et al. was considered to be superior in evaluating prognosis.
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The incidence of endometriosis appears to be increasing, but is possibly due simply to the more widespread use of diagnostic laparoscopy. Whilst a clear pathogenetic role for endometriosis resulting in tubo-ovarian distortion and infertility is obvious, a causal role for mild endometriosis in infertility has not been established. Any one of several factors may result in both endometriosis and infertility. Nevertheless, endometriosis is best treated at the time of diagnosis in order to limit progression of the disease. The preferred method of treatment is medical, with surgery being reserved for those endometriotic lesions not responding to medical treatment. Conservative surgery will not eradicate microscopic foci, and it is possible that the surgery itself may result in adhesion formation. The choice of medication should be individualized, as the side-effects may not be readily tolerated by some women. Maintenance of amenorrhoea may not be essential to therapeutic efficacy, as normally sited and ectopically sited endometrial tissue may respond to hormonal manipulation in different ways.
One hundred fifteen women with carcinoma of the fallopian tube were examined in this retrospective review. A third of the patients were nulliparous and 37% had evidence of old pelvic inflammatory disease. The most common symptoms were bleeding, pain, and/or vaginal discharge. Prognostic factors that predicted death from tumor were the presence of extratubal disease at initial surgery and the bulk of residual tumor left after the initial surgery. With disease limited to the fallopian tube, the depth of invasion of the tubal wall was correlated with the risk of treatment failure. Among patients with disease limited to their fallopian tubes, there was no statistically significant improvement in survival with the addition of either pelvic irradiation or single-agent chemotherapy. Among women with extrapelvic disease, survival improved significantly with the use of cis-platinum-containing multiagent chemotherapy.
The Cavitron ultrasonic surgical aspirator was used for cytoreduction in ten patients with intra-abdominal malignancy (nine ovarian and one fallopian tube). The mean age was 65 years, and eight patients had stage IIIC disease. Standard surgical techniques were used to resect the adnexa, uterus, and omentum. The Cavitron was used to remove disease from the diaphragm, spleen, stomach, and small bowel without resection or injury. These nongenital viscera would have required resection using surgical techniques for cytoreduction. The mean Cavitron surgical time was 49 minutes. Cytoreduction by the Cavitron facilitates tumor removal and reduces the requirement for nongenital visceral resection.
A patient who was 61 years of age had obstruction of the thoracic duct by metastases from an adenocarcinoma of the endometrium together with a carcinosarcoma of the tube. She developed chylous ascite. The diagnostic approach and the treatment has been reviewed by the authors.
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A benign teratoma of the fallopian tube occurred in association with a tubal pregnancy. This rare finding should be considered when two masses are present within a fallopian tube.
The clinical and cytologic findings in ten cases of primary fallopian tube carcinoma, a very rare malignancy, are presented. All ten patients had vaginal pool (V), cervical (C), endocervical (E) and endometrial aspiration (EA) smears examined preoperatively; peritoneal smears were also prepared from cul-de-sac fluid aspirated during surgery. In the preoperative cytodiagnosis, some of V, C, E and EA smears were positive for malignant cells in six of the ten patients (60%). Examination of the EA smear was the most effective means of discovering this disease. A watery discharge was noted in two patients, both of whom were negative in the preoperative cytodiagnosis. In such patients, it is necessary to repeat the smear examinations. The cytologic appearance of this disease is contrasted to that of endometrial carcinoma.
Between 1950 and 1986, 14 cases of primary carcinoma of the fallopian tube were treated and diagnosed at the Cancer Institute Hospital. These cases constituted 0.13% of the total number of gynecologic malignancies at the hospital during the period. The clinical/pathological findings and prognoses were described. Of the 14 cases, the average age was 56.0 years. The most frequent symptom was atypical genital bleeding, seen in 11 cases (79%). Massive watery discharge was seen in four cases (29%). In preoperative cytologic examination of vaginal smears, six cases (43%) were positive for cancer. All cases underwent operation as therapy. Postoperative irradiation, adjuvant chemotherapy, and/or second-or third- look operation was also used. Histopathologically, all materials were found to be adenocarcinoma. Four cases were well differentiated, seven were moderately differentiated, and three were poorly differentiated. Two patients with stage III and IV cancers died of the disease. Nine patients were still alive at the end of this study. The five-year survival rate was 57% (4/7). In stage I cancers, the five-year survival rate was 80% (4/5). The prognosis of stage I cancer patients was estimated as rather good.
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The authors report a case of tubal choriocarcinoma discovered by chance during an ectopic pregnancy. The literature was reviewed on this subject. The treatment vary according to the authors, but, it would seem that chemotherapy has clearly modified the prognosis. But, we must realize that, with such a rare disease, diagnosis and treatment are sometimes difficult to obtain.
Results of a 7-year follow-up review of a patient with intratubal cancer and lumbo-aortic glands invasion are reported. The highly lympholytic character of these tumors and the existence of elective lumbo-aortic lymph node metastases suggest that surgery should include routine bilateral lumbo-aortic curettage in tubal cancer, particularly stages I and IIA. As well as providing improved assessment of degree of extension of the disease it can also avoid the frequently poorly tolerated abdominopelvic radiotherapy.